Suicide attempts and suicidal ideation in patients with obsessive-compulsive disorder: A systematic review and meta-analysis

•More than 1/10 patients with OCD attempts suicide during his/her lifetime.•Nearly half of all individuals with OCD have suicidal ideation.•Severity of obsessions is the main risk factor for suicide in OCD.•Compulsions have a comparatively protective effect.•Clinicians should address obsessions and...

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Bibliographic Details
Published in:Journal of affective disorders 2020-11, Vol.276, p.1001-1021
Main Authors: Pellegrini, Luca, Maietti, Elisa, Rucci, Paola, Casadei, Giacomo, Maina, Giuseppe, Fineberg, Naomi A., Albert, Umberto
Format: Article
Language:English
Subjects:
Female
Humans
Male
Obsessive-compulsive disorder
Obsessive-Compulsive Disorder - epidemiology
Prevalence
Risk factors
Risk prevention
Suicidal Ideation
Suicide attempts
Suicide, Attempted
Suicide, Completed
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Summary:•More than 1/10 patients with OCD attempts suicide during his/her lifetime.•Nearly half of all individuals with OCD have suicidal ideation.•Severity of obsessions is the main risk factor for suicide in OCD.•Compulsions have a comparatively protective effect.•Clinicians should address obsessions and other specific factors for risk modification. There is controversy on the magnitude of suicide risk in OCD and on the psychopathological features that raise the risk. This systematic review and meta-analysis aims to estimate the pooled prevalence of suicide attempts and suicidal ideation (current/lifetime) in subjects with OCD and identify sociodemographic and clinical factors associated with greater risk. We conducted a literature search in PubMed/Medline, PsycINFO, Web of Science and CINAHL databases up to June 20, 2019, according to PRISMA guidelines. Stata statistical software (Version 15) was used to obtain forest plots, execute subgroup analyses and perform univariate and multivariate meta-regressions. We found 61 eligible studies including OCD patients: 52 investigated suicide attempts and reported a pooled prevalence of 0.135 (95% CI 0.123–0.147); 26 explored current suicidal ideation and reported a pooled prevalence of 0.273 (95% CI 0.214–0.335); 22 researched lifetime suicidal ideation and reported a pooled prevalence of 0.473 (95% CI 0.397–0.548). Severity of obsessions, comorbid substance use and depressive/anxious symptoms increased the risk, whereas compulsions had a comparatively protective effect. Owing to the small number of studies reporting completed suicide rates, this metric was not included in the meta-analysis. The degree of heterogeneity between the studies was high. Clinicians should keep in mind that one out of ten patients with OCD attempts suicide during his/her lifetime, about one third has current suicidal ideation and about half has had suicidal ideation in the past. Several clinical features are associated with increased risk and should be factored into clinical risk management.
ISSN:0165-0327
1573-2517
DOI:10.1016/j.jad.2020.07.115